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General NPI Number Information
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NPI Number | 1831421973
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Entity Type | Organization
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Legal Business Name | CASTLE PINES SURGICAL
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Dates
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Enumeration Date | 01/30/2010
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Last Update Date | 01/30/2010
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Provider Practice Location Address
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Address Line | 761 BRIAR HAVEN DR
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City | CASTLE ROCK
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State | CO
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Zip | 80108-5507
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Country | US
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Telephone | 720-244-8092
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Fax |
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Provider Business Mailing Address
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Address Line | 761 BRIAR HAVEN DR
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City | CASTLE ROCK
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State | CO
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Zip | 80108-5507
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Country | US
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Telephone | 720-244-8092
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Fax |
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Authorized Official
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Title or Position | RNFA
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Name | MR. DOUGLAS SHAWN HANLEY
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Credential |
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Telephone | 720-244-8092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 125255
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License Number State | CO
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